Preventing type 2 diabetes is a high priority for health care systems. Particular focus is needed on racial and ethnic minority populations who suffer disproportionately from diabetes and its complications. Success depends not only on patient access to lifestyle programs to reduce risk, but on patient engagement in such programs. Yet evidence-based strategies to increase engagement in clinical settings are lacking. This K01 career development award will provide Susan D. Brown, PhD with the expertise needed to achieve her long- term goal of reducing health disparities in diabetes by engaging diverse at-risk patients, such as overweight and obese women with a history of gestational diabetes, in preventive programs in health care settings. This proposal examines whether two theory-driven outreach strategies, tailored diabetes risk information and self- affirmation, impact three initial and sustained patient engagement outcomes: patient responses to outreach materials, and participation and retention in a lifestyle program. The central hypothesis is that diabetes risk information individually tailored to women's race/ethnicity and diabetes risk factors derived from electronic medical records may increase patient engagement. Yet tailored risk information can be psychologically threatening; thus its effects will be enhanced, and the threat mitigated, when individuals can affirm a sense of self-worth by actively reflecting on values that are important to them. Among overweight/obese women with a history of gestational diabetes, the Specific Aims are as follows. Aim 1: Develop novel, interactive outreach materials to be used in the clinical setting containing tailored diabetes risk information and self-affirmation, in collaboration with patients and health system stakeholders. Aim 2: Experimentally pre-test the impact of the developed outreach materials on patient responses in a 2 (tailored vs. non-tailored) x 2 (self-affirmation vs. no self-affirmation) design. Aim 3: Experimentally pilot test the impact of interactive outreach materials on patient engagement in a health system lifestyle program, as compared to standard outreach; I will also explore effects on weight loss. This theory-based research in a real-world clinical setting will expand our limited knowledge base regarding patient engagement for diabetes prevention. Dr. Brown will benefit from the primary mentorship of Assiamira Ferrara, MD, PhD, Senior Research Scientist and Section Chief for Women's and Children's Health at the Kaiser Permanente Northern California Division of Research. Complementing Dr. Brown's strengths in clinical psychology and obesity treatment, this K01 award will provide systematic training overseen by experts in diabetes and diabetes prevention (Dr. Ferrara), implementation science (Constance Weisner, DrPH, MSW and Julie Schmittdiel, PhD), health disparities (Alyce Adams, PhD), and biostatistics (Charles Quesenberry, PhD) to ensure Dr. Brown's success as an independent diabetes prevention investigator.